Vaccine hesitancy and contemporary health narratives among medical students in Kazakhstan: insights from a post-soviet information environment

The health information environment is characterised by rapid circulation of scientific evidence, misinformation and conspiracy narratives. Validated psychometric instruments capture stable predispositions toward conspiracy thinking but are less suited to continuously evolving health narratives, particularly in multilingual post-Soviet societies, where historical experience, institutional trust and a shared Russian-language information environment shape exposure to health information. This study examined medical students’ agreement with contemporary health-related statements and its association with vaccination in Kazakhstan. A cross-sectional, anonymous online survey was conducted among medical students at Marat Ospanov West Kazakhstan Medical University (Aktobe) in January–March 2024 (977 analysed responses; >80% of eligible students). The questionnaire, developed through literature review, expert consultation and pilot testing, comprised 28 statements of varying scientific credibility. Sparse principal component analysis identified patterns of co-endorsed statements, and logistic regression examined predictors of COVID-19 and influenza vaccination. Agreement varied substantially across statements (“don’t know”: 13.8–46.9%); overt conspiracy claims (e.g., vaccine microchips, 10.5%) were far less endorsed than generalised distrust or pseudomedical claims (e.g., that scientists conceal adverse effects, 51.2%). Four descriptive thematic dimensions — General, Alternative Medicine, Virus-denialist and Population Control — jointly explained 43.5% of variance; all were weakly and negatively associated with year of study, a tentative pattern given the uneven distribution of respondents across years. Declared beliefs were weakly related to vaccination: among students strongly endorsing vaccine effectiveness, 32.4% (COVID-19) and 42.3% (influenza) were unvaccinated, whereas 59–62% of those strongly endorsing microchip or depopulation narratives were vaccinated. Conspiracy beliefs contributed negligibly to predicting vaccination; health-conscious behaviours (e.g., attending the doctor when sick, sunscreen use) and demographic factors were stronger predictors. Medical students’ agreement with contemporary health-related narratives is multidimensional and only loosely coupled to vaccination behaviour, suggesting that declared beliefs are a poor proxy for actual uptake. In Kazakhstan, this pattern appears shaped by the interaction of individual cognition, institutional trust and a shared, historically contested Russian-language information environment, rather than by conspiracy belief alone. Medical education may be more effective if it builds transferable critical-appraisal and media-literacy skills and addresses the institutional roots of distrust, rather than narrowly correcting individual beliefs.